Rothbaum Barbara Olasov, Price Matthew, Jovanovic Tanja, Norrholm Seth D, Gerardi Maryrose, Dunlop Boadie, Davis Michael, Bradley Bekh, Duncan Erica J, Rizzo Albert, Ressler Kerry J
Am J Psychiatry. 2014 Jun;171(6):640-8. doi: 10.1176/appi.ajp.2014.13121625.
The authors examined the effectiveness of virtual reality exposure augmented with D-cycloserine or alprazolam, compared with placebo, in reducing posttraumatic stress disorder (PTSD) due to military trauma.
After an introductory session, five sessions of virtual reality exposure were augmented with D-cycloserine (50 mg) or alprazolam (0.25 mg) in a double-blind, placebo-controlled randomized clinical trial for 156 Iraq and Afghanistan war veterans with PTSD.
PTSD symptoms significantly improved from pre- to posttreatment across all conditions and were maintained at 3, 6, and 12 months. There were no overall differences in symptoms between D-cycloserine and placebo at any time. Alprazolam and placebo differed significantly on the Clinician-Administered PTSD Scale score at posttreatment and PTSD diagnosis at 3 months posttreatment; the alprazolam group showed a higher rate of PTSD (82.8%) than the placebo group (47.8%). Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only. At posttreatment, the D-cycloserine group had the lowest cortisol reactivity and smallest startle response during virtual reality scenes.
A six-session virtual reality treatment was associated with reduction in PTSD diagnoses and symptoms in Iraq and Afghanistan veterans, although there was no control condition for the virtual reality exposure. There was no advantage of D-cycloserine for PTSD symptoms in primary analyses. In secondary analyses, alprazolam impaired recovery and D-cycloserine enhanced virtual reality outcome in patients who demonstrated within-session learning. D-cycloserine augmentation reduced cortisol and startle reactivity more than did alprazolam or placebo, findings that are consistent with those in the animal literature.
作者研究了与安慰剂相比，联用D - 环丝氨酸或阿普唑仑增强的虚拟现实暴露疗法在减轻军事创伤所致创伤后应激障碍（PTSD）方面的有效性。
在一次介绍性会议之后，156名患有创伤后应激障碍的伊拉克和阿富汗战争退伍军人参与了一项双盲、安慰剂对照的随机临床试验，其中五节虚拟现实暴露疗法课程分别联用了D - 环丝氨酸（50毫克）或阿普唑仑（0.25毫克）。
在所有治疗条件下，创伤后应激障碍症状从治疗前到治疗后均有显著改善，并在3个月、6个月和12个月时得以维持。在任何时间，D - 环丝氨酸组和安慰剂组之间的症状没有总体差异。阿普唑仑组和安慰剂组在治疗后临床医生评定的创伤后应激障碍量表评分以及治疗后3个月的创伤后应激障碍诊断方面存在显著差异；阿普唑仑组的创伤后应激障碍发生率（82.8%）高于安慰剂组（47.8%）。仅对于D - 环丝氨酸组，疗程间消退学习是治疗效果的特异性增强因素。在治疗后，D - 环丝氨酸组在虚拟现实场景中的皮质醇反应性最低，惊吓反应最小。
尽管虚拟现实暴露疗法没有对照条件，但六节虚拟现实治疗课程与伊拉克和阿富汗退伍军人创伤后应激障碍诊断及症状的减轻相关。在主要分析中，D - 环丝氨酸对创伤后应激障碍症状没有优势。在次要分析中，阿普唑仑损害恢复，而D - 环丝氨酸在表现出疗程内学习的患者中增强了虚拟现实治疗效果。与阿普唑仑或安慰剂相比，联用D - 环丝氨酸更多地降低了皮质醇和惊吓反应性，这些发现与动物文献中的结果一致。
